To review current literature relating to the adverse effects of the angiotensin-converting enzyme (ACE) inhibitors.

Online drug information sources, including MEDLINE (1966–November 1994), Iowa Drug Information Service, and the Australasian Medical Index (AMI), were used to identify relevant literature, including reviews.

Data were extracted from studies described in the English-language literature dealing with the adverse effects of ACE inhibitors. Comprehensive reviews and relevant case reports also were included.

Important adverse effects of ACE inhibitors include first-dose hypotension, renal dysfunction, hyperkalemia, and cough. Less common adverse effects include angioedema, hepatotoxicity, skin rashes, and dysgeusia. ACE inhibitors also are associated with adverse fetal effects; thus, this class of drugs is contraindicated in pregnancy. Some adverse effects of ACE inhibitors are predictable on the basis of the fundamental pharmacology of this class of drugs. However, other effects are idiosyncratic in nature, although these reactions are generally much less common.

Attention to the principles of risk assessment, risk minimization, and patient monitoring are important when ACE inhibitor therapy is used for any indication. Provided these steps are taken, ACE inhibitors are generally a safe and effective class of drugs.